Brain surgery last week, then coming to ED for pain. Wait 4 hours to be seen.

[happy2learn]

Nurses, I want to know your take on this situation.

I'm not a nurse, just a student. I volunteer at the ED. Families talk to me about what's going on and I listen.

This family came in and you could just see something wasn't right. They started talking to me and their son had been in the ED since last night. He had brain surgery last week. He came in because he said he felt pressure and pain in his head. They had him wait 4 hours.

Now, I know I don't know very much, but it just seemed like to me that if a person comes in with that kind of pain and they knew he had surgery, wouldn't it be more of a priority to get him seen? This guy clearly felt horrible. My immediate was reaction was well what if there was bleeding in the brain, which is exactly what the family was concerned about.

They were so polite, just the nicest people, despite what they were going through. I know the doctor and nurse didn't answer all of their questions and they did leave today, but you could tell they were not satisfied at all. I gave them the patient relations number and advised them to speak with them about the matter.

As a nurse, would you think that he should have been a higher priority, at least to make sure there wasn't any bleeding? I know I don't have any more details really to give, but based on just all of that info, what do you think?

I'm going to assume the nurses and docs did the right thing, but people do make mistakes. I'm just curious what your experience would tell you.

Thanks!

[Mike A. Fungin RN]

It's really hard to say. Some pain and/or pressure can be normal, he did have brain surgery. The urgency of the situation would have to be judged based on the severity of his pain, neuro presentation, vital signs, etc.

I'm not one to Monday morning quarterback based on second hand and likely biased information. Try not to get in the middle.

[Nascar nurse, ASN, RN]

I am not an ER nurse & don't pretend to be one BUT.. there are to many variables here to give any kind of answer

1. I would assume that someone triaged him upon arrival to the ER. If he was alert/oriented, speaking clearly, not stumbling around, not complaining of blurred vision, vitals stable (if taken), etc and main complaint was pain....I would assume he would not necessarily be "high priority".

2. Who else/what else was going on in the ER that IS HIGH PRIORITY... I don't know the answers to that & you probably don't either.

Yep, people make mistakes...but also some people just have to wait their turn too. The history of brain surgery doesn't make him top of the list, especially if respiratory, cardiac, trauma patients are piling in too.

DISCLAIMER: Not an ER nurse, hoping someone will come along

[happy2learn]

I'm not looking to "get in the middle" of anything. I'm just curious. That's all.

The waiting 4 hours isn't biased. I can look that up.

[Fribblet]

Pain after surgery is expected. A triage assessment would be completed. Just because he had brain surgery, does not make him top priority.

Someone having an MI, the dude who walked in after getting shot and the person EMS is rolling down the hall with while doing compressions are going to take priority.

Since you do not yet have experienced RN assessment skills or ED experience, no one here can really say whether or not this person was made to wait unnecessarily. Even if this guy needed to be seen quickly, you cannot start tossing sick people out of rooms. If all rooms are full, then all rooms are full.

This is life in the ED.

[fiveofpeep]

a 4 hour wait actually sounds pretty good to me

[happy2learn]

4 hours isn't bad when it's busy, some were waiting 6 today. Some will probably wait 8 tonight. Too many car accidents in one day.

Good points made. Thank you.

[Nascar nurse, ASN, RN]

There were 10 MVA's, all lucky to be alive. 2 were rollovers.

This is from the other thread you have about a rude nurse. This kinda explains why the poor fellow had to wait 4 hours to be seen.

[happy2learn]

The MVA's were today. This guy came in last night.

It's usually pretty busy at night. I just thought maybe it would be more of a priority but I see it's not. I was just curious.

[Ruby Vee, BSN]

just a question . . . do you have issues with nurses? because from this thread and your last one, you seem to be judging nurses rather harshly. in this thread, it almost seems as if you think you know better than the triage nurses about who should be a priority and who should not.

[jlr820]

i'm an ed nurse. this is hard to answer with the information given. i'm sure that he was triaged upon arrival by an experienced rn (focused history and neuro exam, vitals, etc). i just have to believe that he was triaged appropriately and had no neuro deficits, stable vitals and probably made a "yellow" level 3. the other issue here is "do we have a room or hall bed to put this patient in?" and "what else is coming through the door right this second that might be a higher priority. sounds like this client had some post-op headache pain, but was otherwise stable. i'm sorry that he waited four hours. i'm sure if there had been any hint of neurological deterioration either upon arrival or during a waiting room reassessment, they would have found a way to get him back immediately. we in ed genuinely do try to do our best for patients...many times, though our "best" and their "best" are not the same thing.

[RN1980]

if a fella walks into my er and declares that his head is hurting enough for him to come in with his hx of past brain surgeries he is gonna get a fast neuro eval in triage, a quick phone call to er charge nurse and 9 times out of 10 a quick w/chair trip to the ct-scan. the issue of liability is just so great for this. even if the er is very busy, you need to squeeze this guy into the scanner fast.its basically the same situation if a abd/back pain with hx of aaa walks in, you get superfast set of films.